45-year-old woman in respite has cellulitis on her left leg. She is also prediabetic and cannot be managed with lifestyle modifications.
Patient is at high risk of developing cardiovascular disorder. She is currently taking amlodipine 10mg every day for hypertension. Recently, blood tests revealed that she has diabetes. She is starting metformin 500mg twice per day.
Discuss the potential treatment outcomes and discuss with your prescriber the pharmacotherapy plans that support the prescription of metformin.
Discuss your expectations regarding metformin therapy and the desired outcomes. Monitor and evaluate treatment outcomes and make recommendations for continued therapy.
Discuss patient education regarding drug adherence.
Discuss the benefits and risks of medications and discuss conditions that may require dosage adjustments.
The topic of diabetes has gained traction in medical discourses in particular today’s modern world.
According to recent research, diabetes rates have increased. This is attributed by medical experts to lifestyle changes.
There are many medication options that have been developed to treat this disease.
Metformin has been identified as the main medication to be used for this purpose.
Metformin, a type 1 diabetes medication, is ideal.
Metformin has the overall purpose of lowering blood sugar levels and improving insulin metabolism (Zaccardi, et al. 2016).
Metformin is prescribed to patients suffering from diabetes when diet and exercise are not sufficient to lower blood sugar.
This paper discusses the pharmacotherapy plans supporting the decision and need for metformin. We also discuss the potential pharmacotherapeutic considerations related to dosing, drug interaction and treatment-related outcome. We discuss expected therapy goals, monitoring and evaluation of treatment results, and make recommendations for continued treatment based on patient factors (Sonesson Johansson Johnsson and Gause-Nilsson 2016, 2016).
Discussion of patient education and drug adherence.
Discuss the benefits and risks of drugs as well as conditions that may require dose adjustments.
This will be done in reference to 45 year patient in respite.
Pharmacotherapy Plan to Support the Choice and Need to Prescribe Metformin
A plan often includes information about patients and metformin.
For this 45-year old patient who is in respite, the patient must carefully read and understand the entire information before taking metformin.
If there are any questions, patients should ask their doctors.
Primarily, 45-year olds are expected to follow the doctors’ meal plan.
Importantly, this is an essential step for controlling a person’s condition and is vital if the medicine is to work (Tahrani Barnett & Bailey 2016, 2016).
A patient should be able to perform a prescribed exercise routine in order to test for sugar in their blood or urine.
Metformin should be taken together with meals to help reduce any side effects.
The patient should swallow the tablet.
It should be normal and not cause panic.
Take the tablet and drink a glass of water. Do not crush or chew it.
Also, it is important to measure the oral liquid using a marked measuring spoon, an oral syringe or medicine cup.
The reason this is necessary is that the average household teaspoon may not be able to hold the correct amount of liquid.
A patient must remember that they should only take the metformin prescribed by their doctor.
It is important to remember that different brands might not be suitable for treating diabetes.
In approximately one to two week, the patient 45 years old may notice some improvement.
Full blood glucose regulation effects can take up to three months (Lu Min. Chuang. Kokubo. Yoshida. & Cha. B2016).
Patients may now feel free to ask their doctor any questions they might have about the subject.
Do You Need To Prescribe Metformin?
A number of reasons exist for a physician to prescribe metformin.
The reason that a doctor prescribes metformin to patients is to prolong their lives.
Metformin is linked to nearly 24 percent less mortality in patients who have taken it, according to research.
Metformin is also said to help with weight loss and normalize hypertension.
Given that the patient has hypertension, this medication should be of benefit to him.
Metformin can be used to treat diabetes type 2 and improve heart health.
This is why metformin prescriptions are necessary.
Metformin could help this 45-year old patient to manage diabetes.
Pharmacotherapeutic Consideration in Relation To Dosing, Drug To Drug Interaction
Medical practitioners must take into account a variety of factors before deciding how much medication to give to a patient.
This is why the dose of metformin for each patient will be different.
The instructions on the label as well as those given by doctors must be followed.
If the dose for a particular patient differs, the doctor will direct you to adjust the dose.
A person’s ability to take the right amount of medicine greatly depends on how strong the medicine is.
A person’s medical condition, which may be prescribed medicine, is also important to take into account when determining the dose.
This will determine the number and duration of each dose taken each day.
Even though it is not advised to mix certain drugs, there are cases when multiple medicines can be used together.
Doctors may sometimes alter the prescribed doses for patients or use other precautions if necessary.
If you are taking metformin, it is vital that your doctor knows if you’re taking any other medication.
Metformin should not be taken in combination with certain medicines.
Iopanoic Acid (Diatrizoate), Iobenzamic Acid (Iopromide), Iopromide and Iodipamide are just a few of the medicines that should not be taken with metformin.
Although they are not advised to be taken with metformin at all, some medicine can still be used.
Some of these medications include Aspirin (Norfloxacin), Balofloxacin (Bapropion), and Balofloxacin (Balofloxacin).
It is possible to have side effects from metformin and these medications may be harmful.
Primarily, amlodipine sylate works as an add-on therapy for a variety of agents.
Amlodipine is a medication that improves the function of the endothelial cells and reduces inflammation.
The use of this medication may also be helpful in improving the cardiovascular outcome.
Metformin and Diabetes: The Action
Metformin can be described as an antihyperglycemic medication that helps to improve glucose tolerance in 45-year-olds with type 2 diabetes.
Metformin’s main action is to lower not only the basal, but also the postprandial blood glucose.
This is the pharmacological mechanism of action and is distinct from other antihyperglycemic medications.
Metformin has the following functions: it lowers hepatic glucose, decreases overall glucose absorption by the intestine, and improves insulin sensitivity through increased peripheral uptake of glucose.
Metformin, unlike sulfonylureas does not cause hypoglycemia in type-2 diabetes patients or people in a normal state.
Metformin Treatment Outcomes, Goals, Monitoring and Evaluation
In order to achieve an intended outcome, each medication strategy must be directed by specific goals.
This is why there are several general goals when it comes to diabetes treatment with metformin.
When treating diabetic patients, the goal is to reduce the acute decompensation and maintain a good standard of living. It also aims to prevent or delay the onset of late illnesses and complications.
The patient must achieve therapeutic goals when treating diabetes.
Glycosylated hemoglobin, or HbA1c, is often considered to be the best indicator of overall diabetes control. This is because it provides information about how well a patient’s glycemic control has been maintained in recent months.
It is important to set a therapeutic goal for patients with lower expectancies and older patients.
The target value, especially for the patient’s lipid profile and blood pressure, is crucial. Ischemic heart illness is the leading cause of death in diabetic patients.
Therefore, patients with diabetes have a cardiovascular system that is similar to patients without diabetes who have already been diagnosed as having ischemic heart disease.
Patients with coronary illness need to have their overall targets values as strict as possible.
The 45-year-old patient with diabetes type 2 is likely to experience a different outcome if she takes metformin.
Diabetes patients are more likely to develop heart disease.
The expected outcome of this therapy is to reduce the risk of a patient suffering from heart failure (Hadjadj. Rosenstock. Meinicke. Woerle., 2016).
Metformin therapy can also affect the quality of a patient’s life.
The medication is intended to reduce the risks of diabetes, such as heart failure.
A patient who is considered an older adult may have a lower life expectancy.
This is where the current therapy may increase the patient’s life expectancy.
Metformin therapy also aims to lower cognitive impairment and improve the patient’s overall cognitive status over time.
Metformin Monitoring and Evaluation
For a complete recovery, it is essential to track a patient’s progress during the first few weeks of metformin treatment.
To check the medication’s unwanted effects, it is essential to obtain blood samples as well as urine testing.
Metformin can sometimes interact with the dye used for X-rays and CT scans.
Patients should be advised by doctors to stop taking metformin prior to any type of medical exam or diagnosis.
If the kidney function of the patient is normal, then it might be advised that metformin be taken within 48 hours.
It is crucial to ensure that all doctors and dentists who are treating diabetes patients understand that the patient uses metformin.
It is also recommended that the patient stop taking metformin at least seven days prior to any surgery or medical test. (Chrvala Sherr and Lipman, 2016).
Some cases can lead to lactic acidosis if too much metformin is taken.
Monitoring a patient is essential in this situation and ensuring that he or she seeks medical attention before things get worse.
The use of metformin is a great way to treat and control type-2 diabetes (Shanbhogue. Mitchell. Rosen. & Bouxsein. 2016).
For the best long-term outcome, however, it is necessary to monitor the patients who are taking metformin.
To achieve this, doctors need to know at all times if a patient is taking metformin therapy.
This is the only way to ensure a thorough and effective monitoring process.
It is true, diabetes type 2 is treated with lifestyle changes, especially in older adults.
Most patients fail to maintain the target levels of glycated hemoglobin after receiving a very successful metformin treatment response. This is especially true for patients who have been on medication for three to five consecutive years.
Patients should consider a second medication, especially if they have not met their individual glycemic treatment goals (Dujic and colleagues, 2016).
The A1C outcomes are often used to guide this decision. They are usually done every three to six month after the initial therapy.
Patients who do not achieve their goal on the first treatment are advised to take additional medications.
These include insulin, GLP-1 (glucagon-like Peptide-1 (GLP-1) agonists), repaglinide, as well as insulin (Kohler and al., 2016).
Patients need to be aware of the fact that every recommended medication has both its benefits and drawbacks, particularly in relation to their overall effect on a specific patient.
A1Cs greater than 8.5% on overall metformin or patients with obstinate signs of hyperglycemia are recommended to be added insulin (American Diabetes Association 2016, 2016).
GLP-1 receptor-agonist is an alternative to basal insulin, which has long been considered the best medicine to add during metformin treatment. This is especially true when A1C is elevated.
Some patients may have a history of heart disease, such as Storgaard, Bagger and Knop.
It is possible to use a GLP-1 receptor agonist that has shown initial cardiovascular benefits. However, it is assumed that the patient will achieve the desired result in the long-term.
It is suggested that patients with an A1C below 8 be individualized. This is to ensure that the selection of the second metformin is based on the effectiveness, patient’s overall condition, weight, and any hypoglycemia.
If patients have poor glycemic control, particularly with double therapy, the selection criteria must be individualized. These criteria should be similar to those used for patients who are experiencing mono-therapy failure.
If patients fail to achieve a targeted A1C, they should switch to insulin therapy or the GLP-1 receptor-agonist (Lipska Krumholz, Soones and Lee, 2016).
Patients on metformin and sulfonylureas who are still in their initial stages of using it, may have to be stopped while being tapered.
Metformin can be continued as usual in these cases.
There are patients with a history of strokes or myocardial infection. They should also be prescribed two oral agents in addition to a GLP-1 antagonist.
A third recommendation is to use three goals for patients close to their goals in terms of glycemic control.
Patient Education in Relation To Drugs Adherence
Medication compliance is the ability to follow the prescriptions of a doctor and to take the medication as prescribed by them (Sastre Vernooij Harmand & Martinez 2017, 2017).
Recent trends in pharmacy practice have highlighted the issue of medication non-adherence (Rosenstock, et al. 2016).
This is made worse by the fact that in many clinical settings in contemporary society, there is very little measurement of patient adherence to medication.
Designing a patient education strategy to ensure drug adherence is crucial.
Although there are many instances of patients not adhering to prescribed medication, not all prescription misuses are intentional (Softeland, et al. 2016).
Most cases of unintentional nonadherence occur when patients are unable to control their circumstances and wish to follow prescribed treatment plans.
To reduce instances of drug non-adherence, nurses can engage patients in issuing prescriptions.
Patients can be included in the decision-making process when issuing prescriptions, which nurses can do (Goldstein & MullerWieland 2016, 2016).
This is essentially a case where a more collaborative approach will increase patient’s cooperation.
By involving the patient in the decision making process, medical professionals allow patients to feel more ownership, which makes them feel more invested in their own recovery (Ahren and al., 2017).
A simple drug regime can help car providers increase prescription compliance.
Care providers are able to communicate with patients and explain what is important in a prescription.
This is when medical professionals can educate patients on the type and manner they should follow the prescribed medication.
Patients should also be informed about any side effects associated with prescriptions (Nauck, et al. 2016).
Metformin therapy is delicate. Patients need to be informed about how to follow prescribed instructions.
The most common reason for non-adherence is forgetfulness.
Nearly half the patients prescribed medication for forgetting to take them at some point (Qaseem. Barry. Humphrey. & Forciea. 2017).
This is where nurses use a common tool to remind patients to follow their treatment regimen, including voice messages, text messages, and postal mails (Chapman, Darling, & Brown, 2016.
Through education, nurses can remind their patients to check their emails regularly and to follow the prescribed treatment.
Nurses can also help patients understand the details of their medication. This helps to avoid situations where one is unable to comprehend.
This can be especially useful for patients with complex prescriptions.
Risk and benefit of drugs, and condition that may be adjusted
The fact that there are no safe medicines is not enough to be effective. Each medicine has side effects and some may occur in certain patients (Gaede, et al. 2016).
This is one reason why the benefit of a certain medicine should always outweigh its risk.
Metformin has many benefits that make it an excellent medication for diabetes type 2.
Metformin promotes healthy gut bacteria (Chatterjee Khunti & Davies 2017, 2017).
Recent research has shown that metformin is likely to have a favorable effect on the microbiota.
This is achieved by allowing mucin to degrade.
Pre-diabetes are also protected from type–diabetes by taking metformin (Tian, et al. 2016,).
The lifestyle changes can help prevent pre-diabetes from developing type 2 diabetes.
Metformin can also help protect glaucoma.
Metformin is a medication that has been used to treat diabetes. It does have some benefits.
A diabetic patient might encounter some of the following risks after taking metformin: Gastrointestinal adverse effect, diarrhea, which is only a small percentage of metformin users (Wu and al., 2016, Wu et al.).
However, metformin is not a dangerous drug and can be avoided by following the doctor’s instructions.
It is clear that diabetes has become an epidemic in our modern society. This can be directly attributed to our lifestyle.
People are more likely to be overweight if they don’t exercise enough or eat properly. This can lead to diabetes.
Diabetes is most common in older people. Here’s an example of a 45-year old woman suffering from cellulitis.
Patients with diabetes should be able to live a better quality life.
Metformin therapy is a proven treatment for diabetes.
Metformin therapy is effective in treating diabetes, despite the risks.
Type 2 diabetes.
The Lancet 389(10085), 2239-2251.
Association between vitamin B12 deficiency and metformin in patients with type-2 diabetes: A systematic review.
Diabetes & Metabolism. 42(5): 316-327.
One-daily liraglutide and lixisenatide: A 26-week randomized controlled clinical study.
Diabetes Care, doi: dc152479.
The safety and efficacy (or lack thereof) of once-weekly semaglutide or once-daily sitagliptin for patients with type 2 diabetes (SUSTAIN2): A double-blind, 56-week-long, phase 3a, randomized study.
The Lancet Diabetes & Endocrinology 5, 343-354.
For drug-naive type 2, initial combination therapy with canagliflozin and metformin or each component alone.
Diabetes Care, Dc151736.
Empagliflozin as an add-on therapy for patients with type 2 Diabetes that is not controlled with metformin or linagliptin: A 24-week randomized, double-blind parallel-group trial.
Diabetes Care, 40(2) 201-209.
A systematic review of network meta-analysis and systematic review of sodium?glucose/cotransporter?2 inhibitions in type 2 diabetes mellitus.
Diabetes, Obesity & Metabolism, 18, 783-794.
A meta-analysis of cardiovascular effects of dapagliflozin on patients with type-2 diabetes and other risk groups:
Cardiovascular Diabetology. 15(1): 37.
Current drugs for type 2 diabetes mellitus: Pharmacology and therapeutic implications.
Nature Reviews Endocrinology (12(10)), 566.
American Diabetes Association.
Type 2 Diabetes prevention and delay.
Diabetes Care, 39 (Supplement 1): S36-S38.
Type 2 diabetes responders and nonresponders: Pathophysiologic differences in responders and those who eat very low calories and maintain their weight for 6 months
Diabetes care, Dc151942.
Type 2 diabetic patients are treated with metformin.
Diabetic Medicine, 33(4) 511-514.
Evaluation of bone density and bone biomarkers among patients with type-2 diabetes treated with canagliflozin.
The Journal of Clinical Endocrinology. 101(1): 44-51.
Patients with type 2 diabetes: Metformin and the risk of developing kidney cancer.
European Journal of Cancer 52, 19-25.
The effect of diabetes self-management education on adults with type 2 Diabetes Mellitus: A systematic review.
Patient education, counseling, 99(6) 926-943.
A systematic review of SGLT-2 inhibitors for the treatment of type 2 diabetes mellitus.
Meta-analysis: Effects of metformin in determining survival rates for patients with lung cancer and type 2 diabetes mellitus.
Clinical and Translational Oncology (18(6), 641-649.
Type 2 diabetes and the skull: new insights into sweet bone structure
The Lancet Diabetes & Endocrinology. 4(2). 159-173.
A clinical practice update of the American College of Physicians on oral pharmacologic treatments of type 2 diabetes mellitus.
Annals of Internal Medicine, 166(4): 279-290.
Type 2 Diabetes: Principles and Practice
Phase 3 results of a placebo-controlled, double-blind multicenter trial. Efficacy and safety of ipragliflozin for Asian patients with type 2.
Journal of Diabetes Investigation, 7(3), 366-373.
Patients with type 2 diabetes mellitus or microalbuminuria can expect to live for years thanks to multifactorial interventions. The 21-year follow up on the Steno-2 randomized study has shown that there have been many years of improvement in their lives.
Empagliflozin safety and tolerance in type 2 diabetes patients
Clinical Therapeutics, 38(6). 1299-1313.
The role of polypharmacy for the elderly patient: A review on glycemic control among older adults with type 2.
The development of cognitive impairments and dementia is affected by Type 2 diabetes mellitus treatment.
Cochrane Database of Systematic Reviews. (6)
After treatment with Sodium-Glucose Cotransporter-2 inhibitor, diabetic ketoacidosis is seen in a Type 2 diabetic patient.
Basic & Clinical Pharmacology and Toxicology, 118(2). 168-170.
Initial combination of empagliflozin & metformin for type 2 diabetes patients.
Diabetes Care, Dc160522.